This is not something I have any real influence over because the tests ordered on a patient’s first visit to the PFT lab are going to be determined by the ordering patterns of the referring physician and not by what I think. It’s still a worthwhile question, however.
There are no standards for PFT ordering. There are recommendations from the ATS, ERS, ACCP and NIH regarding patient diagnosis and treatment for a variety of pulmonary diseases and buried inside of them are some guidelines for PFT tests. What I’ve seen, however, is that these guidelines are honored far more in the breach than in their observance. As an example, for asthmatics the NIH recommends spirometry during an initial visit, after asthma has been stabilized, during an exacerbation, after an exacerbation and at least every 1 to 2 years otherwise. How often do you see this guideline followed in more than spirit?
I never used to think about this too much but several years ago I had a long conversation with a Pulmonary lab manager at a tertiary care hospital in Australia. One of the things he said was that all patients newly referred to the Pulmonary division there always had a complete set of PFTs, including post-bronchodilator spirometry, MIP & MEP and an ABG before they even saw a pulmonary physician. The ABG may be a bit of overkill, but since that time I now spend a lot less time on the front lines and lot more time reviewing PFT reports. I have a more global view of patient management (or at least I like to think I do) and I have to wonder if complete PFTs on a first visit shouldn’t be a standard approach.